Folate Vs. Folic Acid: The Two Faces Of Vitamin B9

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Folate Vs. Folic Acid

Folate is natural while folic is synthetic form of folate. Folate is processed in the small intestine while folic acid is first processed in the liver and converted to folate before being available for different biochemical and physiological processes in the body. Folate can help prevent health problems like heart disease, certain cancers, and birth defects. However, while high levels of folate is quite safe, too much folic acid in the body can mean increased health problems.

The huge amount of information on food, health, and wellness available today can get confusing sometimes. The terms folate and folic acid, for instance, are a typical example. Are folate and folic acid the same thing? Or are they different? The answer: they are different – and yet, they aren’t! We have the lowdown on both these B9 vitamin forms.

The B9 Vitamin

Folic acid and folate are essentially part of the vitamin B family. Here’s a quick look at what B vitamins, also known as B-complex vitamins, do for us:

  • They help our bodies produce energy by converting carbohydrates into glucose.
  • They enable the body to use the available fats and proteins.
  • They keep our liver, hair, skin, and eyes healthy.
  • They aid in the proper functioning of our nervous system.
  • The B vitamins work in combination with other nutrients to maintain several body functions.1

Among the family of eight B vitamins, vitamin B9 is referred to as folate or folic acid. In that sense, folate and folic acid are the same, referring to the same nutrient. There are differences, however.

Folate Vs. Folic Acid: Know The Differences

1. Folate Is Natural While Folic Acid Is Synthetic

Folate is found naturally in foods such as green leafy vegetables, fruits, and seeds. Folic acid, on the other hand, does not exist naturally and is the synthetic version of vitamin B9. It is a highly oxidized and stable compound. You may also hear folate referred to as folacin – but don’t let that fox you!2

Folic acid is prescribed as a supplement for managing various conditions. In the United States, it is also used to fortify widely consumed foods like breakfast cereals, bread, and other grains.3

2. Folic Acid Is Converted Into Folate In The Body Before Its Use

Although folic acid is absorbed faster by the body than folate, it must first be converted to folate in the body before being available for different biochemical and physiological functions. Folate is processed in the small intestine while folic acid is first processed in the liver before being converted to folate.4

3. Folate Protects Against CVD, But Folic Acid May Not

A diet rich in folate is associated with a lowered risk of cardiovascular disease (CVD), including stroke, coronary artery disease, and myocardial infarction or heart attack.5 Folate works together with vitamins B6 and B12 to regulate levels of homocysteine, an amino acid present in our blood. High levels of homocysteine are believed to be connected with heart disease, although the exact connection is still not very clear.6

Folic acid supplements also reduce homocysteine levels, but it is not clear whether CVD risks are similarly lowered. In fact, tests show that the expected reduction in CVD risks does not happen with folic acid in spite of lowered blood homocysteine levels.7

4. Bioavailability Of Folate Is Slightly Lower

Although both folate and folic acid are two forms of vitamin B9, they are not equal in terms of bioavailability. It has long been considered that the bioavailability of folate from a diet rich in fruits, vegetables, and liver is a little less than that of folic acid and is pegged at about 80–85 percent.8 Studies, however, show that bioavailability depends on factors such as the food matrix. Consuming a mixed diet that includes foods rich in folate can be just as effective as taking folic acid supplements.9

5. Unabsorbed Folic Acid Can Cause Health Problems

Folic acid is first processed in the liver before being available as folate for various metabolic functions. However, the liver has limited ability to process folic acid, resulting in unmetabolized folic acid remaining in circulation.10 This unmetabolized folic acid in the blood plasma can sometimes create some of the following health problems.

Folic Acid Masks Deficiency Of Vitamin B12

Experts say that too much folic acid may mask symptoms of anemia, which is an early sign of vitamin B12 deficiency. B12 is essential for maintaining nerve health and a deficiency could result in confusion, dementia, and even permanent damage to the nerves, spinal cord, and brain. Vitamins B9 and B12 usually work in tandem to help in the formation of red blood cells and, together, they can help fight anemia. This is why the reduced availability of vitamin B12 may often go unnoticed.11 Although vitamin B12 deficiency is not very common, it could be a problem among older people who either cannot absorb it or just don’t get enough. Strict vegetarians need to be careful about vitamin B12 deficiency too.12

Unmetabolized Folic Acid Decreases Natural Killer (NK) Cell Efficiency

In one study, circulating folic acid was found to decrease the efficiency of Natural Killer (NK) cells. These cells are part of our immune system and can kill many types of normal and virus-infected cells, including tumor cells. This finding, however, still needs to be corroborated with larger studies.13

Unmetabolized Folic Acid Promotes Growth Of Cancer Cells

Recent research shows that too much folic acid in our bodies can block the entry of natural folate into the cells.14 While folate and folic acid can fight cancer cells when consumed within a limit, this equation flips when folic acid supplementation is too high. The balance appears to be quite tricky.

Folate lowers cancer risk: Studies show that folate-rich foods could reduce the chances of colorectal cancer, pancreatic cancer, and esophageal cancer. Such a diet may also reduce the risks of breast cancer after menopause, especially among women who have a family history of breast cancer. Other cancers, such as those of the stomach, prostate, ovaries, and lungs, do not appear to be affected either way by a folate-rich diet.15

Although it is not understood how exactly folate prevents cancer, it is believed to promotes DNA health and prevent mutations that could lead to cancer. It is also believed that a person consuming a folate-rich diet is probably consuming a healthy diet and that is what is lowering the risk of cancer.16

But high folic acid may raise cancer risk: Large amounts of folic acid may accelerate the transformation of any existing abnormal tissues to cancer. Cancer cells require more nourishment than normal cells as they rapidly multiply. In other words, a tumor needs folate to keep growing. Thus, for people who have cancer or have been detected with precancerous growths, folic acid supplements could prove to be detrimental. Dietary folate should be enough.17

Folate absorption inefficient with alcohol: Here’s a look at yet another scenario. Since alcohol in the blood prevents our bodies from absorbing folate, it has been observed that women who drink alcohol regularly, 1.5–2 drinks a day, are more vulnerable to breast cancer. Fortunately, increasing dietary folate can reduce the risk of breast cancer among women who consume more than one alcoholic drink per day.18

Role of Folate And Folic Acid In Growth And Development

Folate And Genetics

Folate has a crucial role in synthesizing DNA, the building blocks of our genetic makeup. It also promotes cell growth.19

And as we saw earlier, as a B9 vitamin, folate also plays a vital role in many other bodily functions.

Folate For Healthy Babies

Birth defects: Pregnant women need a folate-rich diet to cut the risk of their babies developing birth defects like spina bifida and anencephaly. Studies prove that low levels of folate in pregnant women are linked to these birth defects. The incidence of such defects is also vastly reduced when pregnant women take folic acid supplements.20

Cleft lips: Taking folic acid and multivitamin supplements along with natural sources of folate during pregnancy could help prevent the development of cleft lip in babies.21

Autism and developmental delays: Folic acid supplementation during pregnancy may also lower the risk of a baby developing autism and delay in developing language skills by 3 years of age.22

Emotional problems: Other research indicates that mothers with low folate levels run the risk of giving birth to babies with emotional problems.23

Folate Deficiency And Its Implications

Besides factors like excessive alcohol consumption and smoking, some ailments like inflammatory bowel disease and celiac disease may cause folate deficiency because of inefficient absorption.

Folate deficiency can trigger many health problems:

  • Reduced appetite
  • Poor growth
  • Gingivitis
  • Diarrhea
  • Memory loss
  • Mental dullness
  • Irritability
  • Inflammation of the tongue
  • Changes in skin, hair or fingernail color
  • Heart palpitations
  • Megaloblastic anemia, symptoms of which include shortness of breath, fatigue, and weakness24 25 26

How Much Folate Do We Need?

Since folate or B9 vitamin is water-soluble and not stored in our bodies, it must be sourced from the diet. However, if there is a shortfall, it’s relatively safe to consume folic acid in recommended amounts as a dietary supplement. Remember, though, taking over 1000 mcg per day over a long period can tip the balance and lead to symptoms like irritability or intestinal malfunctions, not to mention the possible effects of unmetabolized folic acid we already mentioned.27

The recommended dietary allowance for folic acid supplements varies according to age:

  • Children (1–13 years): 150 mcg–300 mcg per day
  • Adolescents (14–18 years): About 400 mcg per day
  • Adults (19 years and above): 400 mcg per day
  • For expectant mothers, the recommended amount of folic acid is 600 mcg per day. Women planning a pregnancy should also ensure they are getting the standard adult dose of 400 mcg per day as neural tube defects in the fetus can develop in the early days after conception or even before pregnancy is confirmed.28
  • Breastfeeding mothers need a folic acid intake of 500 mcg per day.29
  • Significantly, older adults must get the recommended daily allowance of folate (400 mcg) from a multivitamin supplement as well as folate-rich foods. This is because blood levels of homocysteine tend to increase with advancing age, hiking up the likelihood of heart disease.30

Sources Of Folate And Folic Acid

The term folate is derived from “foliage”, and as you’d have guessed correctly, green, leafy vegetables are among the richest sources of folate.31

Here’s a list of folate-rich foods with enough options to please the pickiest eater:

The Dietary Guidelines for Americans recommends that, like other nutrients, we should get our folate requirement from natural foods as far as possible. Dietary supplements and fortified foods can help bridge the gap when natural food sources fall short or are not available.32 But as far as possible, natural is the best way to go!

  • Green, leafy vegetables: Asparagus, broccoli, Brussels sprouts, mustard greens, romaine lettuce, spinach, turnip greens
  • Beans: Garbanzo beans, kidney beans, lima beans, mung beans, soybeans, white beans
  • Vegetables: Beet, carrots, cauliflower, celery, corn, okra, peas, root vegetables, squash, tomato, turnip
  • Grains: Whole grains, bulgur wheat, wheat germ
  • Fruits: Avocado, banana, cantaloupe, grapefruit, oranges, papaya, raspberries, strawberries
  • Seafood: Halibut, Dungeness crab, salmon
  • Nuts and seeds: Almonds, flax seeds, peanuts, sunflower seeds
  • Dairy: Milk, cheese, yogurt
  • Meats: Chicken, beef, liver33

Folic acid is used to fortify several foods like bread, flour, cold breakfast cereals, and energy bars.34 Grains and cereals sold in the U.S. are all usually fortified with folic acid. To find out whether a grain-based product has been fortified with folic acid, read the label. As a supplement, you will find folic acid in multivitamins and pre-natal vitamins. It is also available in B-complex dietary supplements or sold under its own name.35

Folic Acid Can Interfere With Other Medication

Folic acid can sometimes interfere with the efficacy of certain prescribed medications – for instance, antibiotics such as tetracycline. Conversely, the presence of certain medications in the blood, such as antacids or non-steroidal anti-inflammatory drugs, can affect the absorption of folate. Speak to your doctor or pharmacist to find out if folic acid will interfere with your existing medications or vice versa.

References   [ + ]

1, 3, 6, 16, 18, 22, 23, 25, 33. Vitamin B9 (Folic acid). University of Maryland Medical Center.
2. Folate. Oregon State University.
4. Folic acid and folate in foods. Harvard Health Publications.
5, 7. Folate. Oregon State University (OSU).
8. Winkels, Renate M., Ingeborg A. Brouwer, Els Siebelink, Martijn B. Katan, and Petra Verhoef. “Bioavailability of food folates is 80% of that of folic acid.” The American journal of clinical nutrition 85, no. 2 (2007): 465-473.
9, 10. Powers, Hilary J. “Folic acid under scrutiny.” British Journal of Nutrition 98, no. 4 (2007): 665-666.
11, 26, 27, 29. Folate. NIH.
12, 14. Folic acid: Too much of a good thing?. Harvard Health Publications.
13. [Troen, Aron M., Breeana Mitchell, Bess Sorensen, Mark H. Wener, Abbey Johnston, Brent Wood, Jacob Selhub et al. “Unmetabolized folic acid in plasma is associated with reduced natural killer cell cytotoxicity among postmenopausal women.” The Journal of nutrition 136, no. 1 (2006): 189-194.
15. Folate and Cancer Risk – Position Statement. Cancer Council NSW.
17. Three Of The B Vitamins. Harvard T. H. Chan School Of Public Health.
19. Vitamin B. Better Health Channel.
20. Czeizel, Andrew E., and István Dudás. “Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation.” New England Journal of Medicine 327, no. 26 (1992): 1832-1835.
21. Wilcox, Allen J., Rolv Terje Lie, Kari Solvoll, Jack Taylor, D. Robert McConnaughey, Frank Åbyholm, Hallvard Vindenes, Stein Emil Vollset, and Christian A. Drevon. “Folic acid supplements and risk of facial clefts: national population based case-control study.” Bmj 334, no. 7591 (2007): 464.
24, 28, 30, 31. Folate. Oregon State University.
32. Folate. NIH.
34. Three Of The B Vitamins. Harvard T. H. Chan School Of Public Health.
35. Folate. NIH.

Disclaimer: The content is purely informative and educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

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